UG Module 8 - Lesson 3

Poorvakarma 

• Collection of Jalauka 

तासां ग्रहणमार्द्रचर्मणा, अन्यैर्वा प्रयोगैर्गृह्णीयात् ||१६||i 

Jalauka has to be collected from water bodies by using wet leather or fresh meat.  This will attract the Jalauka in the water and gets attached to it. Then it should be collected. The best time for collection is śarat ṛtu. 

• Preservation of Jalauka 

अथैनां नवे महति घटे सरस्तडागोदकपङ्कमावाप्य निदध्यात्; भक्ष्यार्थे चासामुपहरेच्छैवलं वल्लूरमौदकांश्च कन्दांश्चूर्णीकृत्य; शय्यार्थं तृणमौदकानि च पत्राणि; त्र्यहात्त्र्यहाच्चाभ्योऽन्यज्जलं [१२] भक्ष्यं च दद्यात्; सप्तरात्रात् सप्तरात्राच्च घटमन्यं सङ्क्रामयेत् ||ii 

Collected Jalauka are kept in a new big earthen pot with little amount of water and mud. Food for jalauka in the form of small pieces of meat, stem of lotus and lily etc. has to be given. The floor of the pot should be arranged with water and small grass. Every third day water and food should be given and every seventh day the pot has to be changed. 

• Selection of Jalauka 

स्थूलमध्याः परिक्लिष्टाः पृथ्व्यो मन्दविचेष्टिताः | 

अग्राहिण्योऽल्पपायिन्यः सविषाश्च न पूजिताः || iii 

Jalauka with broad middle portion, exhausted like and slow in movement on surface, which is not getting attached, slow sucking and saviṣa should be discarded from using for the treatment. 

• Śodhana of Jalauka 

गृहीताश्च ताः सर्षपरजनीकल्कोदकप्रदिग्धगात्रीः सलिलसरकमध्ये मुहूर्तस्थिता विगतक्लमा ज्ञात्वा ताभी रोगं ग्राहयेत् |iv 

After taking the Jalauka from pot, it should be anointed with mustard seed paste and turmeric paste. It should be then placed in a tray containing water in it for 1muhūrta. When the Jalauka becomes active, it should be used for the treatment purpose.  

• Selection of Patient 

अथ जलौकोवसेकसाध्यव्याधितमुपवेश्य संवेश्य वा|v 

Patient have to be checked whether fit for Jalaukavacharana..  

• Preparation of Patient 

विरूक्ष्य चास्य तमवकाशं मृद्गोमयचूर्णैर्यद्यरुजः स्यात् |vi 

After proper snehana and sweda, the oily area has to be rubbed with mud or cow dung.   

Pradhana Karma 

श्लणशुक्लार्द्रपिचुप्रोतावच्छन्नां कृत्वा मुखमपावृणुयात्; अगृह्णन्त्यै क्षीरबिन्दुं शोणितबिन्दुं वा दद्यात्, शस्त्रपदानि वा कुर्वीत; यद्येवमपि न गृह्णीयात्तदाऽन्यां ग्राहयेत् ||vii 

The Jalauka has to be held in hand with the help of soft white cloth or cotton by covering its head and without obstructing its mouth. If Jalauka is not sucking, a drop of milk or blood or even a prick can be given on the site. If the Jalauka is still not attaching another Jalauka has to be taken. 

यदा च निविशतेऽश्वखुरवदाननं कृत्वोन्नम्य च स्कन्धं तदा जानीयाद्गृह्णातीति; गृह्णन्तीं चार्द्रवस्त्रावच्छन्नां कृत्वा धारयेत् ||viii 

When the Jalauka start sucking blood the mouth appears like a horse shoe. It also elevates its neck portion. Then a wet cloth or cotton has to be place over the body of Jalauka. 

दंशे तोदकण्डुप्रादुर्भावैर्जानीयाच्छुद्धमियमादत्त इति; शुद्धमाददानामपनयेतः अथ शोणितगन्धेन न मुञ्चेन्मुखमस्याः सैन्धवचूर्णेनावकिरेत् ||ix 

If swelling, itching etc. appears on the site of bite, it is considered as śuddha Rakta. Then the Jalauka has to be removed. If it doesn’t detach due to smell of blood, Saindhava Cūrṇa can be utilised for detaching. 

Paścāt Karma 

अथ पतितां तण्डुलकण्डनप्रदिग्धगात्रीं तैललवणाभ्यक्तमुखीं वामहस्ताङ्गुष्ठाङ्गुलीभ्यां गृहीतपुच्छां दक्षिणहस्ताङ्गुष्ठाङ्गुलिभ्यां शनैः शनैरनुलोममनुमार्जयेदामुखात्, वामयेत् तावद्यावत् सम्यग्वान्तलिङ्गानीति | 

सम्यग्वान्ता सलिलसरके न्यस्ता भोक्तुकामा सती चरेत् | 

या सीदती न चेष्टते सा दुर्वान्ता, तां पुनः सम्यग्वामयेत् | 

दुर्वान्ताया व्याधिरसाध्य इन्द्रमदो नाम भवति [२३] | 

अथ सुवान्तां पूर्ववत् सन्निदध्यात् ||x 

After proper sucking the blood, the Jalaukā has to be made vomited by using sarṣapa or Saidhava Cūrṇa or Haridra Cūrṇa. The head of the Jalaukā should be held with thumb and index finger of left hand. With the fingers of right hand, the Jalaukā is given mild rubbing from tail end to the mouth for proper vomiting. After proper vomiting the Jalaukā has to be transferred to clear water to see for activeness and search for blood or food. If the Jalaukā appears less active and lack of desire for food, it states improper vomiting. Then it should be subjected again for Samyak Vamana of blood. If the Jalaukā is not properly vomited and reused, it will lead to an asādhya vyādhi called Indramada.  

शोणितस्य योगायोगानवेक्ष्य शतधौतघृताभ्यङ्गः, तत्पिचुधारणं वा; जलौकोव्रणान् मधुनाऽवघट्टयेत्, शीताभिरद्भिः परिषेचयेद्बध्नीत वा, कषायमधुरस्निग्धशीतैश्च प्रदेहैः प्रदिह्यादिति||xi 

After assessment of the proper lakṣaṇas of the vidhi, śatadhauta ghṛta application or its picu application is adviced. The vraṇa can be smeared with madhu or washed with śīta jala. Then, proper bandaging has to be done. Also, pradeha with Kaṣāya, Madhura, Snigdha, Śīta dravyas are also indicated. 

SAMYAK LAKṢAṆA 

दंशे तोदकण्डुप्रादुर्भावैर्जानीयाच्छुद्धमियमादत्त इति|xii 

If swelling, itching etc. appears on the site of bite, it is considered as Samyak Lakṣaṇa. Then the Jalauka has to be removed. 

तत्र विषपित्तरक्तहरां क्रियां कुर्वीत|xiii 

According to Acharya Vagbhata, various measures of Visha hara, Pitta hara and rakta hara treatments can be followed in case of arousal of any complications seen after Jalauka bite.  

तत्र महागदः पानालेपननस्यकर्मादिषूपयोज्यः | 

इन्द्रायुधादष्टमसाध्यम् | 

इत्येताः सविषाः सचिकित्सिता व्याख्याताः ||११||xiv 

Ācārya Suśruta, also advised to use Mahā Agada in the form of Pāna, Alepana and Nasādi Karmas for the management of Saviṣa Jalaukā bite. Whereas, Indramada is considered as incurable one. 

Modern Medicines for Savisha Jalauka bite 

• Initial treatment should include removal of the leech or leeches, controlling blood loss, and preventing exposure to pathogens. 

• Various methods of leech removal have been utilized including salt, saline, vinegar, alcohol, and heat etc. Chemical methods have also been used including lidocaine, and topical anaesthetic spray etc. Saltwater is also very effective in causing the leech to relax and release.  
• After removing the leech, the wound must be cleaned, and bleeding must be stopped. Betadine or topical antibiotic agents like bacitracin / neomycin / polymyxin b can be used to clean the wound.  
• A haemostatic agent or bandage can be used in addition to a pressure dressing to help with haemostasis. Cauterization, local application of tranexamic acid, silver nitrate, suturing of wounds, and tampon use have all be described as methods for achieving haemostasis after a leech bite. Tranexamic acid has also been used to achieve haemostasis. 
• Bacteria of the genus Aeromonas reside within the gut of the leech, and reports of infection after leech therapy have been reported. Prophylactic antibiotics directed like Ciprofloxacin and trimethoprim-sulfamethoxazole are recommended after leech exposure, whether intentional or incidental.